Factors Predicting Sustainability: A Correlational Study of One Multi-Site Program

Healthcare organizations invest significant economic, physical, and human resources to implement changes and expect sustained benefits for their investments in the long term. Yet, few studies have examined long-term sustainability and factors contributingto sustainability. The primary aim of the study was to gain a better understanding of sustainability and five factors (champions, leadership support, policy, resources, and training and education) that might predict long-term sustainability within the context of one Safe Patient Handling and Mobility (SPHM) program implemented in a large, nationwide system more than 7 years ago. The secondary aim was to examine the number of nursing staff injuries, the most notable positive outcome of the program immediately post implementation. Rogers’ Diffusion of Innovation Theory (DOI) was the theoretical rationale. The DOI proposes four essential elements and five stages of the Innovation-Decision Process (IDP). The study focus is within the confirmation stage of the IDP and factors that reflect the DOI essential elements and the literature on sustainability. The methodology included a correlational design and group comparisons. After all necessary approvals, data were collected using mailed surveys and data accessed from the 2011study vdatabase. The participants (n= 73) were Veterans Administration Medical Center (VAMC) SPHM Coordinators. Study instruments included a demographic data form, Five Factor Survey, and the Sustainability Visual Analog Scale (SVAS). Study participants reported high perceived sustainability of the program in their facilities (M= 73.1,SD= 23.6). Multiple regression analyses demonstrated a three-factor model (champions, resources, and training and education), explaining a statistically significant 46% of the variance in sustainability. Statistically significant differences in nursing staff injuries showing continued decline in injuries were found. Study limitations included sample size, limited generalizability, and instrumentation. This research explored predictive factors of sustainability in the largest healthcare system in the United States. The research concluded that the VA SPHM program in the participating facilities and the decline in nursing staff injuries are sustained. Although each ofthe factors showed importance for long-term sustainability, champions, resources, and training and education contributed most significantly as predictors for long-term sustainability. Furthermore, the study supported the importance of DOI processes and elements and provided new information about the role of sustainability in the confirmation stage of the DOI. Recommendations for nursing and research are offered including expanding SPHM implementation, revision of instrumentation, and replication of the immediate post-implementation study

Behavioral profiling of multiple pairs of rats selectively bred for high and low alcohol intake using the MCSF test

Genetic aspects of alcoholism have been modeled using rats selectively bred for extremes of alcohol preference and voluntary alcohol intake. These lines show similar alcohol drinking phenotypes but have different genetic and environmental backgrounds and may therefore display diverse behavioral traits as seen in human alcoholics. The multivariate concentric square field™ (MCSF) test is designed to provoke exploration and behaviors associated with risk assessment, risk taking and shelter seeking in a novel environment. The aim was to use the MCSF to characterize behavioral profiles in rat lines from selective breeding programs in the United States (P/NP, HAD1/LAD1, HAD2/LAD2), Italy (sP/sNP) and Finland (AA/ANA). The open field and elevated plus maze tests were used as reference tests. There were substantial differences within some of the pairs of selectively bred rat lines as well as between all alcohol-preferring rats. The most pronounced differences within the pairs of lines were between AA and ANA rats and between sP and sNP rats followed by intermediate differences between P and NP rats and minor differences comparing HAD and LAD rats. Among all preferring lines, P, HAD1 and HAD2 rats shared similar behavioral profiles, while AA and sP rats were quite different from each other and the others. No single trait appeared to form a common 'pathway' associated with a high alcohol drinking phenotype among all of the alcohol-preferring lines of rats. The marked behavioral differences found in the different alcohol-preferring lines may mimic the heterogeneity observed among human alcoholic subtypes

A New FUSE Survey of Interstellar HD

We have used archival FUSE data to complete a survey of interstellar HD in 41 lines of sight with a wide range of extinctions. This follow up to an earlier survey was made to further assess the utility of HD as a cosmological probe; to analyze the HD formation process; and to see what trends with other interstellar properties were present in the data. We employed the curve-of-growth method, supported by line profile fitting, to derive accurate column densities of HD. We find that the N(HD)/2N(H2) ratio is substantially lower than the atomic D/H ratio and conclude that the molecular ratio has no bearing on cosmology, because local processes are responsible for the formation of HD. Based on correlations with E(B-V), H2, CO, and iron depletion, we find that HD is formed in the densest portion of the clouds; the slope of the logN(HD)/log(H2) correlation is greater than 1.0, caused by the destruction rate of HD declining more slowly than that of H2; and, as a sidelight, that the depletions are density dependent.Comment: 30 pages, 13 figures; Accepted for publication in Ap

Aspiration therapy for the treatment of obesity: 4-year results of a multicenter randomized controlled trial.

BackgroundThe AspireAssist is the first Food and Drug Administration-approved endoluminal device indicated for treatment of class II and III obesity.ObjectivesWe earlier reported 1-year results of the PATHWAY study. Here, we report 4-year outcomes.SettingUnited States-based, 10-center, randomized controlled trial involving 171 participants with the treatment arm receiving Aspiration Therapy (AT) plus Lifestyle Therapy and the control arm receiving Lifestyle Therapy (2:1 randomization).MethodsAT participants were permitted to continue in the study for an additional year up to a maximum of 5 years providing they maintained at least 10% total weight loss (TWL) from baseline at each year end. For AT participants who continued the study, 5 medical monitoring visits were provided at weeks 60, 68, 76, 90, and 104 and thereafter once every 13 weeks up to week 260. Exclusion criteria were a history of eating disorder or evidence of eating disorder on a validated questionnaire. Follow-up weight, quality of life, and co-morbidities were compared with the baseline levels. In addition, rates of serious adverse event, persistent fistula, withdrawal, and A-tube replacement were reported. All analyses were performed using a per-protocol analysis.ResultsOf the 82 AT participants who completed 1 year, 58 continued to this phase of the trial. Mean baseline body mass index of these 58 patients was 41.6 ± 4.5 kg/m2. At the end of first year (at the beginning of the follow-up study), these 58 patients had a body mass index of 34.1 ± 5.4 kg/m2 and had achieved an 18.3 ± 8.0% TWL. On a per protocol basis, patients experienced 14.2%, 15.3%, 16.6%, and 18.7% TWL at 1, 2, 3, and 4 years, respectively (P < .01 for all). Forty of 58 patients (69%) achieved at least 10% TWL at 4 years or at time of study withdrawal. Improvements in quality of life scores and select cardiometabolic parameters were also maintained through 4 years. There were 2 serious adverse events reported in the second through fourth years, both of which resolved with removal or replacement of the A tube. Two persistent fistulas required surgical repair, representing approximately 2% of all tube removals. There were no clinically significant metabolic or electrolytes disorders observed, nor any evidence for development of any eating disorders.ConclusionsThe results of this midterm study have shown that AT is a safe, effective, and durable weight loss alternative for people with class II and III obesity and who are willing to commit to using the therapy and adhere to adjustments in eating behavior

Spatial and temporal melt variability at Helheim Glacier, East Greenland, and its effect on ice dynamics

This is the publisher's version, also available electronically from "http://onlinelibrary.wiley.com".[1] Understanding the behavior of large outlet glaciers draining the Greenland Ice Sheet is critical for assessing the impact of climate change on sea level rise. The flow of marine-terminating outlet glaciers is partly governed by calving-related processes taking place at the terminus but is also influenced by the drainage of surface runoff to the bed through moulins, cracks, and other pathways. To investigate the extent of the latter effect, we develop a distributed surface-energy-balance model for Helheim Glacier, East Greenland, to calculate surface melt and thereby estimate runoff. The model is driven by data from an automatic weather station operated on the glacier during the summers of 2007 and 2008, and calibrated with independent measurements of ablation. Modeled melt varies over the deployment period by as much as 68% relative to the mean, with melt rates approximately 77% higher on the lower reaches of the glacier trunk than on the upper glacier. We compare melt variations during the summer season to estimates of surface velocity derived from global positioning system surveys. Near the front of the glacier, there is a significant correlation (on >95% levels) between variations in runoff (estimated from surface melt) and variations in velocity, with a 1 day delay in velocity relative to melt. Although the velocity changes are small compared to accelerations previously observed following some calving events, our findings suggest that the flow speed of Helheim Glacier is sensitive to changes in runoff. The response is most significant in the heavily crevassed, fast-moving region near the calving front. The delay in the peak of the cross-correlation function implies a transit time of 12–36 h for surface runoff to reach the bed

Chaotic Scattering in Heavy--Ion Reactions

We discuss the relevance of chaotic scattering in heavy--ion reactions at energies around the Coulomb barrier. A model in two and three dimensions which takes into account rotational degrees of freedom is discussed both classically and quantum-mechanically. The typical chaotic features found in this description of heavy-ion collisions are connected with the anomalous behaviour of several experimental data.Comment: 35 pages in RevTex (version 3.0) plus 27 PostScript figures obtainable by anonymous ftp from VAXFCT.CT.INFN.IT in directory kaos. Fig. 1 upon request to the authors. To be published in the October Focus issue on chaotic scattering of CHAO

Simultaneous genetic analysis of means and covariance structure: Pearson-Lawley selection rules

The object of this paper is to indicate that the Pearson-Lawley selection rules form a plausible general theory for the simultaneous genetic analysis of means and covariance structure. Models are presented based on phenotypic selection and latent selection. Previously presented quantitative genetic models to decompose means and covariance structure simultaneously are reconsidered as instances of latent selection. The selection rules are very useful in the context of behavior genetic modeling because they lead to testable models and a conceptual framework for explaining variation between and within groups by the same genetic and environmental factors. © 1994 Plenum Publishing Corporation

The Astropy Problem

The Astropy Project (http://astropy.org) is, in its own words, "a community effort to develop a single core package for Astronomy in Python and foster interoperability between Python astronomy packages." For five years this project has been managed, written, and operated as a grassroots, self-organized, almost entirely volunteer effort while the software is used by the majority of the astronomical community. Despite this, the project has always been and remains to this day effectively unfunded. Further, contributors receive little or no formal recognition for creating and supporting what is now critical software. This paper explores the problem in detail, outlines possible solutions to correct this, and presents a few suggestions on how to address the sustainability of general purpose astronomical software

Testing and Assessment in an International Context: Cross- and Multi-cultural Issues

Globalisation, increase of migration flows, and the concurrent worldwide competitiveness impose rethinking of testing and assessment procedures and practices in an international and multicultural context. This chapter reviews the methodological and practical implications for psychological assessment in the field of career guidance. The methodological implications are numerous and several aspects have to be considered, such as cross-cultural equivalence or construct, method, and item bias. Moreover, the construct of culture by itself is difficult to define and difficult to measure. In order to provide non-discriminatory assessment, counsellors should develop their clinical cross-cultural competencies, develop more specific intervention strategies, and respect cultural differences. Several suggestions are given concerning translation and adaptation of psychological instruments, developing culture specific measures, and the use of these instruments. More research in this field should use mixed methods, multi-centric designs, and consider emic and etic psychological variables. A multidisciplinary approach might also allow identifying culture specific and ecological meaningful constructs. Non-discriminatory assessment implies considering the influence and interaction of personal characteristics and environmental factors

The Herpesvirus Associated Ubiquitin Specific Protease, USP7, Is a Negative Regulator of PML Proteins and PML Nuclear Bodies

The PML tumor suppressor is the founding component of the multiprotein nuclear structures known as PML nuclear bodies (PML-NBs), which control several cellular functions including apoptosis and antiviral effects. The ubiquitin specific protease USP7 (also called HAUSP) is known to associate with PML-NBs and to be a tight binding partner of two herpesvirus proteins that disrupt PML NBs. Here we investigated whether USP7 itself regulates PML-NBs. Silencing of USP7 was found to increase the number of PML-NBs, to increase the levels of PML protein and to inhibit PML polyubiquitylation in nasopharyngeal carcinoma cells. This effect of USP7 was independent of p53 as PML loss was observed in p53-null cells. PML-NBs disruption was induced by USP7 overexpression independently of its catalytic activity and was induced by either of the protein interaction domains of USP7, each of which localized to PML-NBs. USP7 also disrupted NBs formed from some single PML isoforms, most notably isoforms I and IV. CK2α and RNF4, which are known regulators of PML, were dispensable for USP7-associated PML-NB disruption. The results are consistent with a novel model of PML regulation where a deubiquitylase disrupts PML-NBs through recruitment of another cellular protein(s) to PML NBs, independently of its catalytic activity